The effect of dual tasking and deep brain stimulation frequency parameters on gait in advanced Parkinson's disease

• Published in: Annals of the Indian Academy of Neurology Vol. 23; no. 3; pp. 308 - 312
• Main Authors: Tandra, Swetha, Kandadai, Rukmini, Peddisetty, Ravi, Babu, K, Prabha, T, Jabeen, S, Meena, A, Borgohain, Rupam
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.05.2020; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Brain stimulation; Care and treatment; Deep brain stimulation; Development and progression; Dopamine; dual tasking; Evaluation; Freezing; Gait; Movement disorders; Neurodegenerative diseases; Original; Parkinson disease; Parkinson's disease; Patient outcomes; Patients; Solitary tract nucleus; India; Parkinson's disease; Dual tasking; gait; deep brain stimulation
• ISSN: 0972-2327; 1998-3549
• DOI: 10.4103/aian.AIAN_11_19

Objective: To study the effect of dual tasking and deep brain stimulation frequency parameters on gait in advanced Parkinson's disease Materials and Methods: This is an open label interventional study evaluating 40 post STN-DBS patients with gait disturbances. All patients were diagnosed as PD by a movement disorder specialist using the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) criteria. Patients underwent bilateral subthalamic deep brain stimulation by a qualified neurosurgeon. Patients were managed on a combination of dopamine replacement therapy as well as deep brain stimulation. Patients were assessed by stand walk sit (SWS) test for a 5 meter distance and FOG scoring during medication 'ON' state and device "ON" state, at four frequencies 180, 130, 90, 60 HZ and device "OFF" state. Results: Out of 40 patients, 38 patients showed a significant improvement in gait at a single frequency (best response frequency) which is different for each patient. The mean FOG score showed significant improvement at all stimulation frequencies when compared to OFF stimulation (P < 0.05). The mean number of steps was 18.9 at best response frequency and 21.48 at 130 Hz (P < 0.0001). Number of freezing episodes also were significantly less with best frequency when compared to 130 Hz stimulation (0.28 and 0.65 respectively, (P < 0.0001). The mean FOG score was 6.45 at best frequency and 9.48 at 130 Hz (P < 0.0001). Mean Dual tasking score was 3.53 at best frequency and 5.15 at 130 Hz (P < 0.0002). Conclusion: Optimization of frequency setting for each patient can improve gait and that each patient may have a different optimal frequency.